5. HOW TO STORE VOLTAROL SUPPOSITORIES

6. FURTHER INFORMATION

POM

1. WHAT VOLTAROL SUPPOSITORIES ARE, AND WHAT THEY ARE USED FOR

PATIENT INFORMATION LEAFLET    ^Re^{f 1089/271112/1/F}

Voltarol ®100mg Suppositories

(diclofenac sodium)

3. HOW TO USE VOLTAROL SUPPOSITORIES

Effects on the stomach and digestive system: Constipation, inflammation of the tongue, mouth ulcers, inflammation of the mouth or lips, taste changes, lower gut disorders (including inflammation of the colon) or worsening of ulcerative colitis or Crohn's disease).

Effects on the heart, chest or blood:

Palpitations (fast or irregular heart beat), chest pain, hypertension (high blood pressure), inflammation of blood vessels (vasculitis), inflammation of the lung (pneumonitis), heart disorders, including congestive heart failure or heart attack, blood disorders (including anaemia).

Effects on the liver or kidneys:

Kidney or severe liver disorders, including liver failure, presence of blood or protein in the urine.

Effects on skin or hair:

Serious skin rashes including Stevens-Johnson syndrome Lyell's syndrome and other skin rashes which may be made worse by exposure to sunlight.

6. FURTHER INFORMATION

What Voltarene Suppositories contains

Each suppository contains 100mg of diclofenac sodium as the active ingredient.

Voltarene Suppositories also has the following inactive ingredient: suppository mass 5.

What Voltarene Suppositories looks like and contents of the pack

Voltarene Suppositories are a white to yellowish, torpedo-shaped, with smooth surface and slightly fatty odour and are sealed in a composite foil. Voltarene Suppositories comes in foil packs of 10 Suppositories.

Manufacturer and Licence Holder

This medicine is manufactured by Novartis Pharma S.A.S, 2 and 4 rue Lionel Terray, 92500 Rueil Malmaison, France and are procured from within the EU and repackaged by the Product Licence Holder: Lexon (UK) Limited, Unit 18, Oxleasow Road, East Moons Moat, Redditch, Worcestershire, B98 0RE.

PATIENT INFORMATION LEAFLET    ^Re^{f 1089/271112/2/F}

®

Voltarene 100mg Suppositories

(diclofenac sodium)

Hair loss.

Other side effects that have also been reported include:

Inflammation of the pancreas, impotence. Facial swelling, inflammation of the lining of the brain (meningitis), stroke, throat disorders, confusion, hallucinations, malaise (general feeling of discomfort), inflammation of the nerves in the eye.

Do not be alarmed by this list - most people use Voltarene Suppositories without any problems.

If any of the symptoms become troublesome, or if you notice anything else not mentioned here, please go and see your doctor. He/she may want to give you a different medicine.

If you have any questions or are not sure about anything, ask your doctor or pharmacist. They will have additional information about this medicine and will be able to advise you.

POM

PL 15184/1089

Voltarene is a registered trademark of Novartis AG.

Leaflet revision date: 27/11/12

Blind or partially sighted?

Is this leaflet hard to see or read? Phone Lexon (UK) Limited,

Tel: 01527 505414 for help.

What you need to know about Voltarene Suppositories

Your doctor has decided that you need this medicine to help treat your condition.

Please read this leaflet carefully before you start to use these suppositories. It contains important information.

•    Keep the leaflet in a safe place because you may want to read it again.

•    If you have any other questions, or if there is something you don't understand, please ask your doctor or pharmacist.

•    This medicine has been prescribed for you. Never give it to someone else. It may not be the right medicine for them even if their symptoms seem to be the same as yours.

•    If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

Your medicine is called Voltarene 100mg Suppositories but will be referred to as Voltarene Suppositories throughout this leaflet.

In this leaflet:

1.    What Voltarene Suppositories are, and what they are used for

2.    Things to consider before you start to use Voltarene Suppositories

3.    How to use Voltarene Suppositories

4.    Possible side effects

5.    How to store Voltarene Suppositories

6.    Further information

1. WHAT VOLTARENE SUPPOSITORIES ARE, AND WHAT THEY ARE USED FOR

2. THINGS TO CONSIDER BEFORE YOU START TO USE VOLTARENE SUPPOSITORIES

5. HOW TO STORE VOLTARENE SUPPOSITORIES

Expiry Date

Do not use this medicine after the expiry date shown on the carton or Suppository label. If your doctor tells you to stop taking this medicine, return any unused medicine to your pharmacist for safe disposal. Only keep this medicine, if your doctor tells you to. If your medicine becomes discoloured or shows any other signs of deterioration, consult your pharmacist who will tell you what to d.

Storage

•    KEEP OUT OF THE SIGHT AND REACH OF CHILDREN

•    Do not store above 30°C

•    Protect from heat

Important

Remember this medicine is for you. Only a doctor can prescribe it. Never give your medicine to other people. It may harm them, even if their symptoms are the same as yours. This leaflet does not tell you everything about your medicine. If you have any questions or are not sure about anything, ask your doctor or pharmacist. He/she will have additional information about this medicine and will be able to advise you.

Diclofenac sodium, the active ingredient in Voltarene Suppositories, is one of a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce pain and inflammation.

•    Voltarene Suppositories relieve pain, reduce swelling and ease inflammation in conditions affecting the joints, muscles and tendons including:

-    Rheumatoid arthritis, osteoarthritis, acute gout, ankylosing spondylitis

-    Backache, sprains and strains, soft tissue sports injuries, frozen shoulder, dislocations and fractures

-    Tendonitis, tenosynovitis, bursitis.

•    They are also used to treat pain and inflammation associated with dental and minor surgery.

•    In children aged 1 to 12 Voltarene Suppositories 12.5 and 25 mg are used to treat juvenile chronic arthritis.

•    In children aged over 6 they can also be used alone, or in combination with other painkillers, for the short term treatment of any pain experienced after an operation.

Some people MUST NOT use Voltarene Suppositories. Talk to your doctor if:

•    you think you may be allergic to diclofenac sodium, aspirin, ibuprofen or any other NSAID, or to any of the other ingredients of Voltarene Suppositories. (These are listed at the end of the leaflet.) Signs of a hypersensitivity reaction include swelling of the face and mouth (angioedema), breathing problems, runny nose, skin rash or any other allergic type reaction

•    you have now, or have ever had, a stomach (gastric) or duodenal (peptic) ulcer, or bleeding in the digestive tract (this can include blood in vomit, bleeding when emptying bowels, fresh blood in faeces or black, tarry faeces)

•    you have had stomach or bowel problems after you have taken other NSAIDs

•    you have severe heart, kidney or liver failure

•    you are more than six months pregnant.

•    you suffer from ineffectual straining to empty the bowels, diarrhoea or rectal bleeding

You should also ask yourself these questions before using Voltarene Suppositories:

•    Do you suffer from any stomach or bowel disorders including ulcerative colitis or Crohn's disease?

•    Do you have kidney or liver problems, or are you elderly?

•    Do you have a condition called porphyria?

•    Do you suffer from any blood or bleeding disorder? If you do, your doctor may ask you to go for regular check-ups while you are

using these suppositories.

•    Have you ever had asthma?

•    Are you breast-feeding?

•    Do you have heart problems, or have you had a stroke, or do you think you might be at risk of these conditions (for example, if you have

high blood pressure, diabetes or high cholesterol or are a smoker)?

•    Do you have Lupus (SLE) or any similar condition?

If the answer to any of these questions is YES, discuss your treatment with your doctor or pharmacist because Voltarene Suppositories might not be the right medicine for you.

Are you taking other medicines?

Some medicines can interfere with your treatment. Tell your doctor or pharmacist if you are taking any of the following:

•    Medicines to treat diabetes

•    Anticoagulants (blood thinning tablets like warfarin)

•    Diuretics (water tablets)

•    Lithium (used to treat some mental problems)

•    Methotrexate (for some inflammatory diseases and some cancers)

•    Ciclosporin and tacrolimus (used to treat some inflammatory diseases and after transplants)

•    Trimethoprim (a medicine used to prevent or treat urinary tract infections)

•    Any other NSAID or COX-2 (cyclo-oxgenase-2) inhibitor, for example aspirin or ibuprofen

•    Mifepristone (a medicine used to terminate pregnancy)

•    Cardiac glycosides (for example digoxin), used to treat heart problems

•    Medicines known as SSRIs used to treat depression

•    Oral steroids (an anti-inflammatory drug)

•    Medicines used to treat heart conditions or high blood pressure, for example beta- blockers or ACE inhibitors

•    Voriconazole (a medicine used to treat fungal infections).

•    Phenytoin (a medicine used to treat seizures).

•    Colestipol/cholestyramine (used to lower cholesterol)

Always tell your doctor or pharmacist about all the medicines you are taking.

This means medicines you have bought yourself as well as medicines on prescription from your doctor.

Pregnancy

•    Are you pregnant or planning to become pregnant? Although not common, abnormalities have been reported in babies whose mothers have taken NSAIDs during pregnancy. You should not use Voltarene Suppositories during the last 3 months of pregnancy as it may affect the baby's circulation.

•    Are you trying for a baby? Using Voltarene Suppositories may make it more difficult to conceive. You should talk to your doctor if you are planning to become pregnant, or if you have problems getting pregnant.

Will there be any problems with driving or using machinery?

Very occasionally people have reported that Voltarene Suppositories have made them feel dizzy, tired or sleepy. Problems with eyesight have also been reported. If you are affected in this way, you should not drive or operate machinery.

Other special warnings

•    You should take the lowest dose of Voltarene for the shortest possible time, particularly if you are underweight or elderly.

•    There is a small increased risk of heart attack or stroke when you are taking any medicine like Voltarene. The risk is higher if you are taking high doses for a long time. Always follow the doctor's instructions on how much to take and how long to take it for.

•    Whilst you are taking these medicines your doctor may want to give you a check-up from time to time.

•    If you have a history of stomach problems when you are taking NSAIDs, particularly if you are elderly, you must tell your doctor straight away if you notice any unusual symptoms.

•    If you have a history of stomach problems when you are taking NSAIDs, particularly if you are elderly, you must tell your doctor straight away if you notice any unusual symptoms.

•    Because it is an anti-inflammatory medicine, Voltarene may reduce the symptoms of infection, for example, headache and high temperature. If you feel unwell and need to see a doctor, remember to tell him or her that you are taking Voltarene.

•    VOLTARENE Suppositories 50 mg and 100 mg are not suitable for children.

•    VOLTARENE Suppositories 12.5 mg are not used for adults.

•    Wash your hands.

•    Take out the strip of suppositories and tear off one along the perforation.

•    Then take the suppository out of the plastic wrapping by pulling back the loose end.

•    Then take the suppository out of the plastic wrapping by pulling back the loose end.

3. HOW TO USE VOLTARENE SUPPOSITORIES

The doctor will tell you how to use Voltarene Suppositories. Always follow his/her instructions carefully. The dose will be on the pharmacist's label. Check the label carefully. If you are not sure, ask your doctor or pharmacist. Keep using the suppositories for as long as you have been told, unless you have any problems. In that case, check with your doctor. Suppositories are designed for insertion into the back passage (rectum).

Never take them by mouth.

The doctor may also prescribe another drug to protect the stomach to be taken at the same time, particularly if you have had stomach problems before, or if you are elderly, or taking certain other drugs as well.

Adults

Voltarene Suppositories are normally inserted one, two or three times a day up to a maximum total daily dose of 150 mg.

The number of suppositories you need will depend on the strength which the doctor has given you.

Elderly

Your doctor may advise you to take a dose that is lower than the usual adult dose if you are elderly. Your doctor may also want to check closely that the Voltarene Suppositories are not affecting your stomach, particularly during the first 4 weeks that you are using the suppositories.

Children

For the treatment of chronic juvenile arthritis in children aged 1 to 12:

Doses vary with age, but are usually between 1 and 3 mg/kg body weight every day divided into 2 or 3 doses.

For the treatment of post-operative pain in children aged 6 and over:

Doses vary with age, but are usually between 1 and 2 mg/kg body weight per day divided into 2 or 3 doses for no more than 4 days.

Your child's doctor will work out the dose that is suitable for your child and will tell you how many Voltarene Suppositories to use and how often. Follow his/her instructions carefully. If you are not sure about the dose, check with your doctor or pharmacist.

The doctor may also prescribe another drug to protect the stomach to be taken at the same time, particularly if you have had stomach problems before, or if you are elderly, or taking certain other drugs as well.

How to insert the suppositories

• Empty your bowels before inserting a suppository.

•    Lie on one side with your knees pulled up towards your chest.

•    Gently push the suppository pointed end first into your back passage (rectum) with your finger. Push the suppository in as far as possible as shown in the diagram.

•    Lower your legs and, if possible, stay still for a few minutes.

•    If you feel as if you need to push the suppository out, try to resist this by lying still with your buttocks pressed together. It is important to keep the suppository in the rectum to allow it to melt and the medicine to be absorbed. Pushing the suppository high into the rectum with your finger will help to reduce this feeling.

•    Wash your hands.

The procedure is the same for a child. Once they have emptied their bowels, get them to lie down on their front or side. Gently push the suppository into the child's back passage until it disappears.

Try and stop the child moving around for a few minutes to reduce the risk of the suppository coming out.

What if you forget to take a dose?

If you forget to use a suppository, do not worry.

Use one as soon as you remember. If it is nearly time for your next dose though, just take the next dose and forget about the one you missed.

Do not double up the next dose to make up for the one you missed. Do not insert 2 suppositories at the same time. The total dose should not be more than 150 mg each day if you are an adult.

Children should not take more than the dose that is prescribed by their doctor.

What if you use too many suppositories?

You should not take more than 150 mg in one day if you are an adult.

Children should not take more than the dose that is prescribed by their doctor.

If you accidentally use too many suppositories or use them too often, tell your doctor or go to your nearest casualty department straight away.

4. POSSIBLE SIDE EFFECTS

Voltarene Suppositories are suitable for most people, but, like all medicines, they can sometimes cause side effects.

Some side effects can be serious Stop using the suppositories and tell your doctor straight away if you notice:

•    Stomach pain, indigestion, heartburn, wind, nausea (feeling sick) or vomiting (being sick)

•    Any sign of bleeding in the stomach or intestine, for example, when emptying your bowels, blood in vomit or black, tarry faeces.

•    Allergic reactions which can include skin rash, itching, bruising, painful red areas, peeling or blistering

•    Wheezing or shortness of breath (bronchospasm)

•    Swollen face, lips, hands or fingers

•    Yellowing of your skin or the whites of your eyes

•    Persistent sore throat or high temperature

•    An unexpected change in the amount of urine produced and/or its appearance.

If you notice that you are bruising more easily than usual or have frequent sore throats or infections, tell your doctor.

Voltarene Suppositories may also occasionally cause itching or burning in your back passage or make any haemorrhoids (piles) worse.

The side effects listed below have also been reported.

Common side effects (These may affect between 1 and 10 in every 100 patients):

•    Stomach pain, heartburn, nausea, vomiting, diarrhoea, indigestion, wind, loss of appetite

•    Headache, dizziness, vertigo

•    Skin rash or spots

•    Raised levels of liver enzymes in the blood

•    Irritation where the suppository is inserted.

Rare side effects (These may affect between 1 in every 1000 to 1 in every 10,000 patients:

•    Stomach ulcers or bleeding (there have been very rare reported cases resulting in death, particularly in the elderly)

•    Gastritis (inflammation, irritation or swelling of the stomach lining)

•    Vomiting blood

•    Diarrhoea with blood in it or bleeding from the back passage

•    Drowsiness, tiredness

•    Hypotension (low blood pressure, symptoms of which may include faintness, giddiness or light headedness)

•    Skin rash and itching

•    Fluid retention, symptoms of which include swollen ankles

•    Liver function disorders, including hepatitis and jaundice.

Very rare side effects (These may affect less than 1 in every 10,000 patients):

Effects on the nervous system:

Tingling or numbness in the fingers, tremor, visual disturbances such as blurred vision blurred or double vision, hearing loss or impairment, tinnitus (ringing in the ears), sleeplessness, nightmares, mood changes, depression, anxiety, mental disorders, disorientation and loss of memory, fits, headaches together with a dislike of bright lights, fever and a stiff neck, disturbances in sensation.

Ref: 1089/271112/2/B

Effects on the stomach and digestive system: Constipation, inflammation of the tongue, mouth ulcers, inflammation of the mouth or lips, taste changes, lower gut disorders (including inflammation of the colon) or worsening of ulcerative colitis or Crohn's disease).

Effects on the heart, chest or blood:

Palpitations (fast or irregular heart beat), chest pain, hypertension (high blood pressure), inflammation of blood vessels (vasculitis), inflammation of the lung (pneumonitis), heart disorders, including congestive heart failure or heart attack, blood disorders (including anaemia).

Effects on the liver or kidneys:

Kidney or severe liver disorders, including liver failure, presence of blood or protein in the urine.

Effects on skin or hair:

Serious skin rashes including Stevens-Johnson syndrome Lyell's syndrome and other skin rashes which may be made worse by exposure to sunlight.

Hair loss.

6. FURTHER INFORMATION

What Diclofenac sodium Suppositories contains

Each suppository contains 100mg of diclofenac sodium as the active ingredient.

Diclofenac sodium Suppositories also has the following inactive ingredient: suppository mass 5.

What Diclofenac sodium Suppositories looks like and contents of the pack Diclofenac sodium Suppositories are a white to yellowish, torpedo-shaped, with smooth surface and slightly fatty odour and are sealed in a composite foil.

Diclofenac sodium Suppositories comes in foil packs of 10 Suppositories.

Manufacturer and Licence Holder

This medicine is manufactured by Novartis Pharma S.A.S, 2 and 4 rue Lionel Terray, 92500 Rueil Malmaison, France and are procured from within the EU and repackaged by the Product Licence Holder: Lexon (UK) Limited, Unit 18, Oxleasow Road, East Moons Moat, Redditch, Worcestershire, B98 0RE.

PATIENT INFORMATION LEAFLET    Ref:1089/271112/3/F

Diclofenac Sodium 100mg Suppositories

Other side effects that have also been reported include:

Inflammation of the pancreas, impotence. Facial swelling, inflammation of the lining of the brain (meningitis), stroke, throat disorders, confusion, hallucinations, malaise (general feeling of discomfort), inflammation of the nerves in the eye.

Do not be alarmed by this list - most people use Diclofenac sodium Suppositories without any problems.

If any of the symptoms become troublesome, or if you notice anything else not mentioned here, please go and see your doctor. He/she may want to give you a different medicine.

If you have any questions or are not sure about anything, ask your doctor or pharmacist. They will have additional information about this medicine and will be able to advise you.

POM

PL 15184/1089

Leaflet revision date: 27/11/12

Blind or partially sighted?

Is this leaflet hard to see or read? Phone Lexon (UK) Limited,

Tel: 01527 505414 for help.

What you need to know about Voltarol Suppositories

Your doctor has decided that you need this medicine to help treat your condition.

Please read this leaflet carefully before you start to use these suppositories. It contains important information.

•    Keep the leaflet in a safe place because you may want to read it again.

•    If you have any other questions, or if there is something you don't understand, please ask your doctor or pharmacist.

•    This medicine has been prescribed for you. Never give it to someone else. It may not be the right medicine for them even if their symptoms seem to be the same as yours.

•    If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

Your medicine is called Diclofenac sodium 100mg Suppositories but will be referred to as Diclofenac sodium Suppositories throughout this leaflet.

In this leaflet:

1.    What Diclofenac sodium Suppositories are, and what they are used for

2.    Things to consider before you start to use Diclofenac sodium Suppositories

3.    How to use Diclofenac sodium Suppositories

4.    Possible side effects

5.    How to store Diclofenac sodium Suppositories

6.    Further information

5. HOW TO STORE DICLOFENAC SODIUM SUPPOSITORIES

Expiry Date

Do not use this medicine after the expiry date shown on the carton or Suppository label. If your doctor tells you to stop taking this medicine, return any unused medicine to your pharmacist for safe disposal. Only keep this medicine, if your doctor tells you to. If your medicine becomes discoloured or shows any other signs of deterioration, consult your pharmacist who will tell you what to do.

Storage

•    KEEP OUT OF THE SIGHT AND REACH OF CHILDREN

•    Do not store above 30°C

•    Protect from heat

Important

Remember this medicine is for you. Only a doctor can prescribe it. Never give your medicine to other people. It may harm them, even if their symptoms are the same as yours. This leaflet does not tell you everything about your medicine. If you have any questions or are not sure about anything, ask your doctor or pharmacist. He/she will have additional information about this medicine and will be able to advise you.

1. WHAT DICLOFENAC SODIUM

SUPPOSITORIES ARE, AND WHAT THEY ARE USED FOR

Diclofenac sodium, the active ingredient in Diclofenac sodiumSuppositories, is one of a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce pain and inflammation.

•    Diclofenac sodiumSuppositories relieve pain, reduce swelling and ease inflammation in conditions affecting the joints, muscles and tendons including:

-    Rheumatoid arthritis, osteoarthritis, acute gout, ankylosing spondylitis

-    Backache, sprains and strains, soft tissue sports injuries, frozen shoulder, dislocations and fractures

-    Tendonitis, tenosynovitis, bursitis.

•    They are also used to treat pain and inflammation associated with dental and minor surgery.

•    In children aged 1 to 12 Diclofenac sodium Suppositories 12.5 and 25 mg are used to treat juvenile chronic arthritis.

•    In children aged over 6 they can also be used alone, or in combination with other painkillers, for the short term treatment of any pain experienced after an operation

2. THINGS TO CONSIDER BEFORE YOU START TO USE DICLOFENAC SODIUM SUPPOSITORIES

Some people MUST NOT use Diclofenac sodium Suppositories. Talk to your doctor if:

•    you think you may be allergic to diclofenac sodium, aspirin, ibuprofen or any other NSAID, or to any of the other ingredients of Diclofenac sodium Suppositories. (These are listed at the end of the leaflet.)

Signs of a hypersensitivity reaction include swelling of the face and mouth (angioedema), breathing problems, runny nose, skin rash or any other allergic type reaction

•    you have now, or have ever had, a stomach (gastric) or duodenal (peptic) ulcer, or bleeding in the digestive tract (this can include blood in vomit, bleeding when emptying bowels, fresh blood in faeces or black, tarry faeces)

•    you have had stomach or bowel problems after you have taken other NSAIDs

•    you have severe heart, kidney or liver failure

•    you are more than six months pregnant.

•    you suffer from ineffectual straining to empty the bowels, diarrhoea or rectal bleeding

You should also ask yourself these questions before using Diclofenac sodium Suppositories:

•    Do you suffer from any stomach or bowel disorders including ulcerative colitis or Crohn's disease?

•    Do you have kidney or liver problems, or are you elderly?

•    Do you have a condition called porphyria?

•    Do you suffer from any blood or bleeding disorder? If you do, your doctor may ask you to go for regular check-ups while you are

using these suppositories.

•    Have you ever had asthma?

•    Are you breast-feeding?

•    Do you have heart problems, or have you had a stroke, or do you think you might be at risk of these conditions (for example, if you have high blood pressure, diabetes or high cholesterol or are a smoker)?

•    Do you have Lupus (SLE) or any similar condition?

If the answer to any of these questions is YES, discuss your treatment with your doctor or pharmacist because Diclofenac sodium Suppositories might not be the right medicine for you.

Are you taking other medicines?

Some medicines can interfere with your treatment. Tell your doctor or pharmacist if you are taking any of the following:

•    Medicines to treat diabetes

•    Anticoagulants (blood thinning tablets like warfarin)

•    Diuretics (water tablets)

•    Lithium (used to treat some mental problems)

•    Methotrexate (for some inflammatory diseases and some cancers)

•    Ciclosporin and tacrolimus (used to treat some inflammatory diseases and after transplants)

•    Trimethoprim (a medicine used to prevent or treat urinary tract infections)

•    Lithium (used to treat some mental problems)

•    Methotrexate (for some inflammatory diseases and some cancers)

•    Ciclosporin and tacrolimus (used to treat some inflammatory diseases and after transplants)

•    Quinolone antibiotics (for infections

•    Any other NSAID or COX-2 (cyclo-oxgenase-2) inhibitor, for example aspirin or ibuprofen

•    Mifepristone (a medicine used to terminate pregnancy)

•    Cardiac glycosides (for example digoxin), used to treat heart problems

•    Medicines known as SSRIs used to treat depression

•    Oral steroids (an anti-inflammatory drug)

•    Medicines used to treat heart conditions or high blood pressure, for example beta- blockers or ACE inhibitors

•    Voriconazole (a medicine used to treat fungal infections).

•    Phenytoin (a medicine used to treat seizures).

•    Colestipol/cholestyramine (used to lower cholesterol)

Always tell your doctor or pharmacist about all the medicines you are taking.

This means medicines you have bought yourself as well as medicines on prescription from your doctor.

Pregnancy

•    Are you pregnant or planning to become pregnant? Although not common, abnormalities have been reported in babies whose mothers have taken NSAIDs during pregnancy. You should not use Diclofenac sodium Suppositories during the last 3 months of pregnancy as it may affect the baby's circulation.

•    Are you trying for a baby? Using Diclofenac sodium Suppositories may make it more difficult to conceive. You should talk to your doctor if you are planning to become pregnant, or if you have problems getting pregnant.

Will there be any problems with driving or using machinery?

Very occasionally people have reported that Diclofenac sodium Suppositories have made them feel dizzy, tired or sleepy. Problems with eyesight have also been reported. If you are affected in this way, you should not drive or operate machinery.

Other special warnings

•    You should take the lowest dose of Diclofenac sodium for the shortest possible time, particularly if you are underweight or elderly.

•    There is a small increased risk of heart attack or stroke when you are taking any medicine like Diclofenac sodium. The risk is higher if you are taking high doses for a long time. Always follow the doctor's instructions on how much to take and how long to take it for.

•    Whilst you are taking these medicines your doctor may want to give you a check-up from time to time.

•    If you have a history of stomach problems when you are taking NSAIDs, particularly if you are elderly, you must tell your doctor straight away if you notice any unusual symptoms.

•    Because it is an anti-inflammatory medicine, Diclofenac sodium may reduce the symptoms of infection, for example, headache and high temperature. If you feel unwell and need to see a doctor, remember to tell him or her that you are taking Diclofenac sodium.

•    DICLOFENAC SODIUM Suppositories 50 mg and 100 mg are not suitable for children.

•    DICLOFENAC SODIUM Suppositories 12.5 mg are not used for adults.

How to insert the suppositories

•    Empty your bowels before inserting a suppository.

•    Wash your hands.

•    Take out the strip of suppositories and tear off one along the perforation.

•    Then take the suppository out of the plastic wrapping by pulling back the loose end.

3. HOW TO USE DICLOFENAC SODIUM SUPPOSITORIES

The doctor will tell you how to use Diclofenac sodium Suppositories. Always follow his/her instructions carefully. The dose will be on the pharmacist's label. Check the label carefully. If you are not sure, ask your doctor or pharmacist.

Keep using the suppositories for as long as you have been told, unless you have any problems. In that case, check with your doctor. Suppositories are designed for insertion into the back passage (rectum).

Never take them by mouth.

The doctor may also prescribe another drug to protect the stomach to be taken at the same time, particularly if you have had stomach problems before, or if you are elderly, or taking certain other drugs as well.

Adults

Diclofenac sodium Suppositories are normally inserted one, two or three times a day up to a maximum total daily dose of 150 mg.

The number of suppositories you need will depend on the strength which the doctor has given you.

Elderly

Your doctor may advise you to take a dose that is lower than the usual adult dose if you are elderly. Your doctor may also want to check closely that the Diclofenac sodium Suppositories are not affecting your stomach, particularly during the first 4 weeks that you are using the suppositories.

Children

For the treatment of chronic juvenile arthritis in children aged 1 to 12:

Doses vary with age, but are usually between 1 and 3 mg/kg body weight every day divided into 2 or 3 doses.

For the treatment of post-operative pain in children aged 6 and over:

Doses vary with age, but are usually between 1 and 2 mg/kg body weight per day divided into 2 or 3 doses for no more than 4 days.

Your child's doctor will work out the dose that is suitable for your child and will tell you how many Diclofenac sodium Suppositories to use and how often. Follow his/her instructions carefully. If you are not sure about the dose, check with your doctor or pharmacist.

The doctor may also prescribe another drug to protect the stomach to be taken at the same time, particularly if you have had stomach problems before, or if you are elderly, or taking certain other drugs as well.

•    Lie on one side with your knees pulled up towards your chest.

•    Gently push the suppository pointed end first into your back passage (rectum) with your finger. Push the suppository in as far as possible as shown in the diagram.

•    Lower your legs and, if possible, stay still for a few minutes.

•    If you feel as if you need to push the suppository out, try to resist this by lying still with your buttocks pressed together. It is important to keep the suppository in the rectum to allow it to melt and the medicine to be absorbed. Pushing the suppository high into the rectum with your finger will help to reduce this feeling.

•    Wash your hands.

The procedure is the same for a child. Once they have emptied their bowels, get them to lie down on their front or side. Gently push the suppository into the child's back passage until it disappears.

Try and stop the child moving around for a few minutes to reduce the risk of the suppository coming out.

What if you forget to take a dose?

If you forget to use a suppository, do not worry.

Use one as soon as you remember. If it is nearly time for your next dose though, just take the next dose and forget about the one you missed.

Do not double up the next dose to make up for the one you missed. Do not insert 2 suppositories at the same time. The total dose should not be more than 150 mg each day if you are an adult.

Children should not take more than the dose that is prescribed by their doctor.

What if you use too many suppositories?

You should not take more than 150 mg in one day if you are an adult.

Children should not take more than the dose that is prescribed by their doctor.

If you accidentally use too many suppositories or use them too often, tell your doctor or go to your nearest casualty department straight away.

Some side effects can be serious Stop using the suppositories and tell your doctor straight away if you notice:

•    Stomach pain, indigestion, heartburn, wind, nausea (feeling sick) or vomiting (being sick)

•    Any sign of bleeding in the stomach or intestine, for example, when emptying your bowels, blood in vomit or black, tarry faeces.

•    Allergic reactions which can include skin rash, itching, bruising, painful red areas, peeling or blistering

•    Wheezing or shortness of breath (bronchospasm)

•    Swollen face, lips, hands or fingers

•    Yellowing of your skin or the whites of your eyes

•    Persistent sore throat or high temperature

•    An unexpected change in the amount of urine produced and/or its appearance.

If you notice that you are bruising more easily than usual or have frequent sore throats or infections, tell your doctor.

Diclofenac sodium Suppositories may also occasionally cause itching or burning in your back passage or make any haemorrhoids (piles) worse.

The side effects listed below have also been reported.

Up to 1 in 10 people have experienced:

•    Stomach pain, heartburn, nausea, vomiting, diarrhoea, indigestion, wind, loss of appetite

•    Headache, dizziness, vertigo

•    Skin rash or spots

•    Raised levels of liver enzymes in the blood

•    irritation where the suppository is inserted.

Rare side effects (These may affect between 1 in every 1000 to 1 in every 10,000 patients:

•    Stomach ulcers or bleeding (there have been very rare reported cases resulting in death, particularly in the elderly)

•    Gastritis (inflammation, irritation or swelling of the stomach lining)

•    Vomiting blood

•    Diarrhoea with blood in it or bleeding from the back passage

•    Drowsiness, tiredness

•    Hypotension (low blood pressure, symptoms of which may include faintness, giddiness or light headedness)

•    Skin rash and itching

•    Fluid retention, symptoms of which include swollen ankles

•    Liver function disorders, including hepatitis and jaundice.

Very rare side effects (These may affect less than 1 in every 10,000 patients):

Effects on the nervous system:

Tingling or numbness in the fingers, tremor, visual disturbances such as blurred vision blurred or double vision, hearing loss or impairment, tinnitus (ringing in the ears), sleeplessness, nightmares, mood changes, depression, anxiety, mental disorders, disorientation and loss of memory, fits, headaches together with a dislike of bright lights, fever and a stiff neck, disturbances in sensation.

4. POSSIBLE SIDE EFFECTS

Diclofenac sodium Suppositories are suitable for most people, but, like all medicines, they can sometimes cause side effects.

Ref: 1089/271112/3/B